Organization
GENESSEE VALLEY GROUP HEALTH ASSOC
Active
Other names
LIFETIME HEALTH MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA AMBRES MD (PRESIDENT)
(716) 857-4587
Entity
Organization
Contact information
Practice address
2075 SHERIDAN DR, BUFFALO, NY 14223-1432
(716) 874-1850
(716) 879-3280
Mailing address
2075 SHERIDAN DR, BUFFALO, NY 14223-1432
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
027327
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02619212
—
NY
01
—
3374686
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/22/2006
Last updated
08/22/2020
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